TIME Veterans Affairs

VA Apologizes to Whistleblowers Facing Retaliation

Veterans Health Care
James Tuchschmidt, a top official at the Veterans Health Administration, the VA's health care arm, makes an opening statement while testifying before a House Veterans' Affairs Committee hearing on Capitol Hill in Washington, Tuesday, July 8, 2014. Tuchschmidt said he was sorry that VA employees have suffered retaliation after making whistleblower complaints. Cliff Owen—AP

James Tuchschmidt, the No. 2 official at the Veterans Health Administration, the VA's health care arm, apologized on behalf of the department at a congressional hearing Tuesday night.

(WASHINGTON) — A top official at the Veterans Affairs Department says he is sorry that VA employees have suffered retaliation after making complaints about poor patient care, long wait times and other problems.

James Tuchschmidt, the No. 2 official at the Veterans Health Administration, the VA’s health care arm, apologized on behalf of the department at a congressional hearing Tuesday night.

“I apologize to everyone whose voice has been stifled,” Tuchschmidt said after listening to four VA employees testify for nearly three hours about VA actions to limit criticism and strike back against whistleblowers. “That’s not what I stand for. I’m very disillusioned and sickened by all of this.”

A federal investigative agency said Tuesday it was examining 67 claims of retaliation by VA supervisors against employees who filed whistleblower complaints — including 25 complaints filed since June 1, after a growing health care scandal involving long patient waits and falsified records at VA hospitals and clinics became public.

The independent Office of Special Counsel said 30 of the complaints about retaliation have passed the initial review stage and were being investigated further for corrective action and possible discipline against VA supervisors and other executives. The complaints were filed in 28 states at 45 separate facilities, Special Counsel Carolyn Lerner said.

Instead of using information provided by whistleblowers as an early warning system, the VA often “has ignored or attempted to minimize problems, allowing serious issues to fester and grow,” Lerner told the House Veterans’ Affairs Committee hearing. Worse, officials have retaliated against whistleblowers instead of investigating their complaints, she said.

Lerner said her office has been able to block disciplinary actions against several VA employees who reported wrongdoing, including one who reported a possible crime at a VA facility in New York.

The counsel’s office also reversed a suspension for a VA employee in Hawaii who reported seeing an elderly patient being improperly restrained in a wheelchair. The whistleblower was granted full back pay and an unspecified monetary award, and the official who retaliated against the worker was suspended, Lerner said.

The VA said earlier Tuesday it was restructuring its Office of Medical Inspector following a scathing report by Lerner’s agency last month.

Acting VA Secretary Sloan Gibson said the department would appoint an interim director of the medical inspector’s office from outside the current office and was suspending the office’s hotline immediately. All complaints would be referred to the VA’s Office of Inspector General.

The head of the medical inspector’s office retired June 30 following a report by the Office of Special Counsel saying that his office played down whistleblower complaints pointing to “a troubling pattern of deficient patient care” at VA facilities.

“Intimidation or retaliation — not just against whistleblowers, but against any employee who raises a hand to identify a problem, make a suggestion or report what may be a violation in law, policy or our core values — is absolutely unacceptable,” Gibson said in a statement. “I will not tolerate it in our organization.”

A doctor at the Phoenix veterans hospital, where dozens of veterans died while on waiting lists for appointments, said she was harassed and humiliated after complaining about problems at the hospital.

Dr. Katherine Mitchell said the hospital’s emergency room was severely understaffed and could not keep up with “the dangerous flood of patients” there. Mitchell, a former co-director of the Phoenix VA hospital’s ER, told the House committee that strokes, heart attacks, internal head bleeding and other serious medical problems were missed by staffers “overwhelmed by the glut of patients.”

Her complaints about staffing problems were ignored, Mitchell said, and she was transferred, suspended and reprimanded.

Mitchell, a 16-year veteran at the Phoenix VA, now directs a program for Iraq and Afghanistan veterans at the hospital. She said problems she pointed out to supervisors put patients’ lives at risk.

“It is a bitter irony that our VA cannot guarantee high-quality health care in the middle of cosmopolitan Phoenix” to veterans who survived wars in Iraq, Afghanistan, Vietnam and Korea, she said.

Scott Davis, a program specialist at the VA’s Health Eligibility Center in Atlanta, said he was placed on involuntary leave after reporting that officials were “wasting millions of dollars” on a direct mail marketing campaign to promote the health care overhaul signed by President Barack Obama. Davis also reported the possible purging and deletion of at least 10,000 veterans’ health records at the Atlanta center. More records and documents could be deleted or manipulated to mask a major backlog and mismanagement, Davis said. Those records would be hard to identify because of computer-system integrity issues, he said.

Rep. Jeff Miller, R-Fla., chairman of the House veterans panel, praised Mitchell and other whistleblowers for coming forward, despite threats of retaliation that included involuntary transfers and suspensions.

“Unlike their supervisors, these whistleblowers have put the interests of veterans before their own,” Miller said. “They understand that metrics and measurements mean nothing without personal responsibility.”

Rather than push whistleblowers out, “it is time that VA embraces their integrity and recommits itself to accomplishing the promise of providing high-quality health care to veterans,” Miller said.

TIME Military

Obama Picks Ex-P&G Head Robert McDonald to Lead Veterans Affairs

Robert McDonald, CEO and president of Procter & Gamble, speaks at the Clinton Global Initiative on Sept. 22, 2011 in New York City.
Robert McDonald, CEO and president of Procter & Gamble, speaks at the Clinton Global Initiative on Sept. 22, 2011 in New York City. Mark Lennihan—AP

In tapping McDonald for the post, Obama is signaling his desire to install a VA chief with broad management experience

(WASHINGTON) — President Barack Obama plans to nominate former Procter & Gamble executive Robert McDonald as the next Veterans Affairs secretary, as the White House seeks to shore up an agency beset by treatment delays and struggling to deal with an influx of new veterans returning from wars in Iraq and Afghanistan.

An administration official said Obama would announce McDonald’s appointment Monday. If confirmed by the Senate, McDonald would succeed Eric Shinseki, the retired four-star general who resigned last month as the scope of the issues at veterans’ hospitals became apparent.

In tapping McDonald for the post, Obama is signaling his desire to install a VA chief with broad management experience. McDonald also has a military background, graduating near the top of his class at the U.S. Military Academy at West Point and serving as a captain in the Army, primarily in the 82nd Airborne Division.

The administration official insisted on anonymity in order to confirm McDonald’s appointment before the president’s announcement.

McDonald resigned abruptly from Procter & Gamble in May 2013 amid pressure from investors concerned that he was not doing enough to boost the company’s performance.

McDonald, who had spent 33 years at the consumer products giant, said at the time of his retirement that he believed constant speculation about his job status had become too much of a distraction to the company.

The VA operates the largest integrated health care system in the country, with more than 300,000 fulltime employees and nearly 9 million veterans enrolled for care. But the agency has come under intense scrutiny in recent months amid reports of patients dying while waiting for appointments and of treatment delays in VA facilities nationwide.

Obama dispatched one of his top advisers, Rob Nabors, to the VA to help investigate agency issues and appointed Sloan Gibson as acting secretary while awaiting a permanent replacement.

Nabors and Gibson delivered a scathing report to Obama Friday, citing “significant and chronic system failures” in the nation’s health system. The report also portrayed the Veterans Affairs Department as a struggling agency battling a corrosive culture of distrust, lacking in resources and ill-prepared to deal with an influx of new and older veterans with a range of medical and mental health care needs.

McDonald’s nomination was praised by his peers in the private sector and military.

Jim McNerney, Chairman and CEO of The Boeing Company, called McDonald an “outstanding choice for this critically important position.” Retired U.S. Army General Stanley McChystal, who served with McDonald in the 82nd Airborne, said the nominee’s “business acumen, coupled with his dedication and love of our nation’s military and veteran community, make him a truly great choice for the tough challenges we have at VA.”

House Speaker John Boehner, R-Ohio, called McDonald “a good man, a veteran and a strong leader with decades of experience in the private sector. With those traits, he’s the kind of person who is capable of implementing the kind of dramatic, systemic change that is badly needed and long overdue at the VA.”

Senate Veterans Affairs Committee Chairman Bernie Sanders, I-Vt., said in a statement that he looked forward to meeting with McDonald next week to get his views on issues he views as important.

Among them, Sanders said in a statement, “The VA needs significantly improved transparency and accountability and it needs an increased number of doctors, nurses and other medical staff so that all eligible veterans get high-quality health care in a timely manner.”

McDonald led Procter & Gamble from 2009 to 2013. During that time, the company website states: “P&G realized annual sales of over $84 billion. The company had more than 120,000 employees, 120 plants and 200 brands in 35 categories, of which 25 brands generate over $1 billion in sales each year.”

The company’s Tide detergent, Crest toothpaste and other products can be found in 98 percent of American households. But under McDonald’s leadership, P&G struggled to grow under increased competition and global economic challenges. Critics suggested he was having trouble getting the 150-year-old-plus company to fire on all cylinders.

Investors, including activist investor William Ackman, voiced frustration over the company’s slow revenue growth and stagnant market share gains. Ackman, who took a 1 percent stake in the company, pressed for the company to streamline operations and improve results.

In a letter announcing his retirement from P&G, McDonald wrote, “This has been a very difficult decision for me, but I’m convinced it is what is in the best interests of the company and you.”

In a surprise move, McDonald was replaced by the man he had replaced, former P&G CEO A.G. Lafley.

McDonald has also served on the board of directors of the Xerox Corp., the United States Steel Corp., the McKinsey Advisory Council and the Greater Cincinnati regional initiative intended to “grow high-potential startups” in the Cincinnati region.

McDonald is 61. A native of Gary, Indiana, he grew up in Chicago and graduated from West Point in 1975 with a degree in engineering. He also earned an MBA from the University of Utah in 1978.

TIME politics

Veterans Affairs Needs to Get a Clue About PTSD Treatment

Veterans
Iraq war veteran Zach Choate, 26, leads a group of veterans to a rally on the steps of Russell Building to call for a end to the redeployment of troops who have diagnosed with Post Traumatic Stress Disorder (PTSD). Choate was redeployed while still recovering from wounds inflicted by an IED. Tom Williams—CQ-Roll Call,Inc.

Some medical centers may have a goldmine of PTSD data, which could help improve treatment. If only the department could get its act together.

Both the Departments of Defense and Veterans Affairs spend huge sums every year to treat post-traumatic stress disorder: $294 million and more than $3 billion, respectively, in 2012. But does the treatment help? According to a new congressionally mandated, 300-page report from the Institute of Medicine, neither the Pentagon nor the VA—the two agencies responsible for providing PTSD treatment to soldiers and veterans—have a clue.

The investigating committee found “spikes of excellence in both departments,” said its chairman, Sandro Galea of Columbia University’s Mailman School of Public Health. It also identified “tremendous variability in how care is implemented and an absence of data that tell us if programs are working or not.” Overall, the modest data that do appear in the IOM report are not particularly encouraging.

Members of the expert panel visited some of the VA’s Specialized Intensive PTSD Programs, or SIPPs, which are inpatient or residential programs of up to four months. They reviewed the results of all 39 such programs during 2012 and found that, after four months of treatment, the average patient still qualified for a diagnosis of PTSD.

This isn’t entirely surprising. The VA learned in the 1990s that their 16-week specialty inpatient programs were ineffective, and closed them down. Under political pressure in the 2000s, they started them up again.

But there might be good news—if only we could demonstrate it. After all, the majority of PTSD patients in the VA are not treated in inpatient or residential settings, but as outpatients. Presumably, these patients are better off than those referred to intensive programs.

So how do they fare? Are they better able to benefit from state of the art cognitive-behavioral therapies, such as prolonged exposure and cognitive processing? Clinicians routinely use these interventions to good effect in treating PTSD among civilians. We have every reason to expect that, in most cases, these therapies–in conjunction with psychotherapy and couples or family therapy or medication—have indeed helped veterans.

In any case, the IOM says there are no data. Well, not quite. While not reliably collected across the entire VA health system, there is some tracking information on treatment outcomes. For several years, the VA has required clinicians in every VA medical center to complete a PTSD Checklist (PCL) for each patient every 90 days. The PCL provides a total symptom severity score.

This enables clinicians to track changes in symptoms and establish the optimal frequency of therapy sessions, according to Ron Acierno, former director of the PTSD Clinical Team at the Ralph H. Johnson VA Medical Center in Charleston, S.C. Acierno and his team conducted routine PCLs, though how consistently and completely the surveys were administered at other VA medical centers is unknown.

In medical centers that do comply with the VA mandate to collect PCLs, there may well be a small goldmine of data to be excavated. With this information, we could answer immediate questions about the improvement of veterans’ symptoms and functioning. We could begin to learn what kinds of outcomes we see for younger veterans of the post-9/11 era and Vietnam veterans whose wartime experience is now several decades ago. Yes, Vietnam veterans are very much in the picture as new PTSD patients. One out of every three new patients in 2012 in the VA’s specialized PTSD programs was a Vietnam-era veteran, according to the IOM–even though they last saw military service decades ago.

We could also examine differences in response to treatment between active duty personnel and veterans. Our colleagues tell us, impressionistically, that men and women still in the service are, in general, more motivated than the patients they have treated in the VA. That’s because the culture of the military mental health system aims to help soldiers resume participation, while the VA’s current disability policies often reinforce illness roles and inadvertently pose disincentives to work and recovery because compensation is contingent upon the severity of PTSD.

In establishing PTSD Awareness Day, the Senate resolved to “help ensure that those suffering from the invisible wounds of war receive proper treatment.”

In some, though not all VAs, they do. Now the mission is to ensure quality care is widespread, and to learn whether treatment is helping, who benefits most (and least) and why. Veterans with PTSD deserve the best care possible; accountability is critical to seeing that they get it.

C. Bartley Frueh is chair of the social sciences division at the University of Hawai‘i at Hilo. Sally Satel is a resident scholar at the American Enterprise Institute. Both are former VA clinicians.

TIME Veterans

2 Veterans Affairs Officials Resign in Scandal’s Wake

Following Eric Shinseki's resignation

The Department of Veterans Affairs said Wednesday that two senior officials are stepping down next week as the agency looks to rebound from a scandal over concealing long wait times for veterans to get care.

The VA said the resignation of Will A. Gunn, the current General Counsel, and the replacement of Dr. Robert Jesse, the acting Under Secretary for Health, are “aimed at accelerating Veterans’ access to quality health care and rebuilding the trust of America’s Veterans.”

Jesse served as principal deputy under secretary for health beginning in 2010. In May, he assumed the new position amid reports veterans weren’t receiving adequate care. On July 2, Dr. Carolyn Clancy, who has been at the VA since 2013, will replace him.

“Dr. Carolyn Clancy is a leader and a real innovator when it comes to Veterans’ health care quality and safety,” Acting VA Secretary Sloan Gibson in a statement. “As we conduct our search for an Under Secretary for Health, there’s no one better to take on the issues we face. Dr. Clancy will be charged with the Department’s top priority – getting Veterans off of wait lists and in to see their doctors.”

Gunn’s resignation goes into effect July 3 when he will be replaced by the current principal deputy general counsel Tammy Kennedy. Gibson also announced that Dr. Jonathan Perlin, who served as the undersecretary for health under President George W. Bush, would be returning as a senior advisor to the Acting Secretary.

“We’re pleased to welcome this exceptional leader back to VA,” Gibson added. “I look forward to the contributions of Dr. Perlin who is recognized for his national healthcare leadership roles, as part of the VA team as we continue our work towards accelerating access to care and rebuilding trust with Veterans.”

Secretary of Veterans Affairs Eric Shinseki under fire in May.

“The only way today’s VA personnel actions can be viewed as positive developments is if the department fills the vacancies with leaders who put veterans first—not the VA bureaucracy—focus on solving problems instead of downplaying or hiding them, and understand that taxpayer funded organizations such as VA have a responsibility to provide information to Congress and the public rather than stonewalling them,” Florida Republican Rep. Jeff Miller, who chairs the House Committee on Veterans Affairs, said in a statement.

TIME

Sanders and McCain Introduce VA Reform Bill

Sens. Bernie Sanders and John McCain introduced a far-reaching Veterans Affairs reform bill Monday

Lawmakers are beating the drums of reform to the Veterans Affairs Department, on the heels of another scathing report released by the agency Monday.

The bipartisan bill crafted by Senators Bernie Sanders (I-Vt.) and John McCain (R-Ariz.) would fund construction of 26 new medical facilities and set up ways to make it easier for veterans to seek private care if they do not live near a VA medical facility. The bill would also improve the access to health care for victims of military sexual assault. Democratic Senate leadership said they would like to vote on the legislation this week, an aide tells TIME.

The House Republican leadership has pushed for its own legislation, which passed on a large bipartisan vote last month. That bill would give the VA secretary greater authority to fire or demote poor-performing senior officials.

The newly-introduced Senate bill comes hours after a third Veterans Affairs Department internal audit on Monday, which announced that more than 57,000 veterans have been waiting 90 days or more for their first medical appointments. This audit of the agency’s 731 medical centers found that 13% of schedulers were told by their superiors to doctor schedules to make wait times look shorter. The agency found its 14-day scheduling target unrealistic and will scrap it from employee performance contracts.

The VA wait list scandal led its Secretary, Eric Shinseki, to step down May 30.

TIME White House

Obama Marks Memorial Day With Call for Better Veteran Care

Barack Obama Veterans Memorial Day
U.S. President Barack Obama and Major General Jeffrey Buchanan participate in a wreath laying ceremony at the Tomb of the Unknown Soldier at Arlington National Cemetery in Arlington, Va. on May 26, 2014. Drew Angerer—EPA

Obama, whose administration is currently investigating allegations that Veterans Affairs facilities delayed care for needy veterans, said better support was needed for those who had fought for their country

President Barack Obama paid tribute to America’s fallen members of the armed forces at Arlington National Cemetery in Virginia on Monday to mark the Memorial Day holiday.

Obama, who returned hours earlier from a surprise visit to troops in Afghanistan, pledged again to end the war there by the end of the year and called for better support for America’s veterans, a nod to the recent troubles that have plagued the Department of Veterans Affairs. Veterans Affairs Secretary Eric Shinseki, who has faced calls to resign since it emerged that VA medical facilities had reportedly falsified records to cover up long waits for care, was in attendance.

“We must do more to keep faith with our veterans and their families,” the President said. Those who had fought for their country, he added, must “get the care and benefits they’ve earned and deserve.”

Obama stopped short of directly addressing the issue, but in an interview airing Monday afternoon with CNN, Defense Secretary Chuck Hagel said the idea of veterans on secret waiting lists being denied care “makes me sick to my stomach.”

“Because it is a clear responsibility we have as a country, as a people, to take care of these men and women and their families who sacrificed so much,” said Hagel, who still backs Shinseki. “Let’s see what happened, why it happened, how it happened. Then we’ve got to fix it.”

At Arlington National Cemetery on Monday, Obama also repeated his statement made in Afghanistan on Sunday that the U.S. was at a “pivotal moment” in Afghanistan, reiterating his pledge to pull out most troops by the end of the year.

“By the end of this year, our war in Afghanistan will finally come to an end,” he said.

Obama spoke at Arlington on its 150th anniversary, and harked back to its creation amid the Civil War.

“We declared upon this hill a final resting place for those willing to lay down their lives for the country they loved,” he said.

TIME U.S.

What the VA Did for My Sick Husband

182057792
RodrigoBlanco—Getty Images/Vetta

Amid scrutiny and furor over misconduct at the government agency, a widow gives thanks to the employees who cared for her husband in his last years.

Two weeks ago my husband of 51 years, Joe, died in his room at the William E. Christoffersen Salt Lake Veterans Home at age 87. He had served in the Navy from 1941 to 1946 and was a proud veteran.

Like others, I am deeply concerned by reports of delayed treatment for our veterans. Indeed, when I was receiving cancer treatments in 2011 and could no longer care for Joe at home, we had to wait nearly a month before a room became available in a VA facility.

But this is not a story of disappointment. It is instead one of deep gratitude for the extraordinary professional and personal care Joe received over the next three years. Of course we must not excuse those who betray their responsibilities to our veterans and our country, but we must also remember and celebrate the legion of VA employees who provide outstanding care to our veterans, day in and day out.

As Joe’s physical strength waned and vascular dementia sapped his memory, VA doctors, nurses and aides were alert to his medical needs. Time and again they took him to the VA hospital for tests, diagnosis and treatment.

More unexpected were the countless ways in which their thoughtfulness helped Joe and our entire family. Every veteran was treated with the greatest respect, even when he or she was being difficult. For example, at first Joe didn’t understand why he couldn’t come home with me and became angry whenever I left him. The staff always took him aside to provide comfort and tell him I would be back soon.

These small personal kindnesses made such a difference.

To the extent possible, Joe and other patients were encouraged to continue a normal life. Many activities and facilities were available at the nursing home, but patients were not confined there. There were outings of all sorts, such as professional sporting events, fishing, horse riding, shopping at a local store and short road trips to see the fall leaves—even after Joe was confined to a wheelchair.

Our family was allowed to visit any time of day or night, and staff would place a call for Joe whenever he wanted to talk to us. When he could no longer come home for the day, special dinners were scheduled at holidays so we could celebrate together. It was the little things that mattered the most, and they were the most unexpected.

What turned out to be Joe’s last treat took place the afternoon before his death. By then he was in hospice care, but did not realize that his status had changed. A nurse noticed that he seemed down and asked what would make him happy. He said he wanted a Coca-Cola and a Snickers bar. She pushed his wheelchair so they could fetch them, then brought him back with her to the nurses’ station, where they visited while he indulged in this special snack.

It is difficult to leave a loved one’s side once you know that the final stages of life are here. But we knew that no matter how suddenly Joe’s final decline might be, there was no danger that he would die alone. The staff made sure that someone would always be with any patient who was approaching death so that this would never happen, and that was reassuring for us. As it turned out, the doctor was able to gather most of his family in time to be with Joe as he slipped away. The last three of us, our daughter and son and myself, whose planes from Illinois, Arkansas and Texas did not get us to the nursing home until many hours after his death. The staff had kept Joe in his room to await us. The chaplain, who had come to work for a normal day, stayed until midnight so that she could comfort us after we said our goodbyes. Only then did the mortician take Joe’s body.

A final tradition, so touching that it brings tears to my eyes as I write, is that whenever a veteran dies, his caregivers line the halls to offer their salute and play “Taps” as his flag-draped body departs.

In our case, there was a postscript. Joe had greatly admired the black Converse sneakers of two of the aides. Many times he sought to purchase them from one or the other, once offering a dollar he’d won at Bingo as payment. Although they always declined, the aides decided to surprise Joe by purchasing a pair for him out of their own funds. But the parcel arrived a few hours too late. When I urged them to return the $60 shoes for a refund, they declined, saying they were meant for Joe. Although most mourners at his funeral didn’t realize it, Joe wore his new black sneakers to the grave.

Sandra Collard has five children, fourteen grandchildren and three great grandchildren. Her husband Joe served honorably in the U.S. Navy during World War II.

TIME Veterans

VA Chief Eric Shinseki (Still) Must Go

Eric Shinseki
Veterans Affairs Secretary Eric Shinseki pauses while testifying before the Senate Veterans Affairs Committee hearing to examine the state of Veterans Affairs health care on Capitol Hill in Washington, May 15, 2014. Cliff Owen—AP

The VA is broken. It’s past time to fix this shameful bureaucratic tragedy

Back at the turn of the 21st century, when he left Washington to become president of the New School university in New York City, former Senator Bob Kerrey learned a little something about the ethos of Veterans Affairs. Kerrey, a Medal of Honor recipient who lost part of a leg in Vietnam, needed to get his home address changed. He had called his bank and settled the matter in 10 minutes. He called the VA and spoke to a hostile and not very helpful receptionist. He spoke to the receptionist’s supervisor, who told him, “You’re going to have to come in.” So Kerrey went to the VA office in New York. The receptionist again wasn’t very helpful. Kerrey pointed out that he was only talking about an address change. The receptionist said, “Talk to one of them,” pointing to customer “service” employees sitting at desks labeled A and B. Desk C was vacant. Kerrey went to Desk A, where he was told, “That’s handled by Desk C.” Kerrey asked when the occupant of Desk C was returning. “I don’t know,” said Desk A. Kerrey went over and sat at Desk C for a long while, and then a longer while. He spoke to the supervisor, who had no idea where Desk C was and told Kerrey, “Come back tomorrow.”

“You gotta be kidding,” Kerrey said, or perhaps yelled. It took 12 days to get his address changed.

I’ve heard far more serious VA horror stories ad nauseam in recent years. I know of at least one young Marine who committed suicide while waiting—months—for his medical records to be transferred from Los Angeles to Houston. I’ve also heard stories of heroic treatment performed by devoted VA doctors, nurses and counselors, but those often occurred after their patients endured a Kafka-esque struggle with the VA’s bureaucratic gate-keepers. You might expect that the system, which is staffed largely by older veterans, would have adapted with alacrity to the crisis posed by the wave of wounded Iraq and Afghanistan veterans over the past decade. But the VA’s response has been stagnation, and worse. It is now clear that there was a conscious, and perhaps criminal, effort to camouflage the time veterans had to wait for service in Phoenix and at other VA facilities. It is alleged that 40 veterans died waiting for service in Phoenix; whether or not that proves accurate, we’re facing a moral catastrophe.

The question is, How do we change this situation? The simple answer is leadership, which is why some have called (as I did last year) for VA Secretary Eric Shinseki to resign. By all accounts, Shinseki is a fine man who has spent nearly six years lost in the system. An effective leader would have gone to Phoenix as soon as the scandal broke, expressed his outrage, held a town meeting for local VA outpatients and their families—dealt with their fury face-to-face—and let it be known that he was taking charge and heads were going to roll. Instead, Shinseki intoned the words “mad as hell” at a congressional hearing. And White House chief of staff Denis McDonough said the President was “madder than hell” about the situation. Does anyone actually find this convincing?

The President cares deeply about the troops; he visits the wounded in the hospitals all the time; it’s just not his style to make a public deal of it. But he has been sadly ineffective on the veterans–health issue. The benefits system is still rigged against recent veterans, who go to the end of the line with their claims. Five years ago, Obama promised a unified electronic records system so that a soldier’s medical history would follow him or her seamlessly from active duty to the VA, but it still hasn’t been implemented because of trench warfare between the Pentagon and the VA. More than a billion dollars has been spent on the project. A senior Administration official told me a year ago that a solution was weeks away; now the Administration is promising a new system by 2016. The President could have solved this problem yesterday, by cracking heads—and selecting either the existing VA or Pentagon electronic records system. (Believe it or not, the VA system is pretty effective but not up-to-date.)

The problem of bureaucratic stagnation at the VA (and throughout the rest of the government) could be addressed as well. Think about the lazy clerks Bob Kerrey faced. Why were they so callous? Because under the existing, antiquated civil-service system, they face practically zero threat of being fired. The President could ask for a temporary waiver of civil-service rules to clean up the mess at the VA, but that seems politically impossible. Government accountability is a popular mantra—but you can’t have accountability unless everyone, including Desk C, is held to account.

TIME White House

Adviser: Obama ‘Madder Than Hell’ About VA Scandal

President Obama is urging Veterans Affairs Secretary Eric Shinseki to fix issues in the VA's hospital system after his testimony last week before the Senate Veterans Affairs Committee about reports that at least 40 veterans died while waiting for care at a Phoenix hospital

President Barack Obama is “madder than hell” about reports of long wait times that led to preventable deaths at veterans’ hospitals, according to a top adviser.

White House Chief of Staff Denis McDonough said on Sunday on CBS’s Face the Nation that Obama is urging Veterans Affairs Secretary Eric Shinseki to “continue to fix these things until they’re functioning the way that our veterans believe they should.”

Shinseki himself used similar language last week when he testified in front of the Senate Veterans Affairs Committee about reports that at least 40 veterans died while waiting for care at a Phoenix VA hospital.

“Any allegation about any adverse incident like this makes me mad as hell. I could use stronger language here, Mr. Chairman, but in deference to the committee, I won’t,” Shinseki said on Thursday.

Dr. Robert Petzel, the VA’s top health official, resigned on Friday. House Republicans have also scheduled for Wednesday a vote on legislation that would expand Shinseki’s firing power.

TIME Veterans

Top Veterans Affairs Health Care Official Resigns

Veterans Affairs Secretary Eric Shinseki Testifies Before Senate Robert Petzal
Eric Shinseki, U.S. secretary of Veterans Affairs (VA), left, and Robert Petzel, U.S. VA undersecretary for health, swear in to a Senate Veterans' Affairs Committee hearing in Washington, May 15, 2014. Andrew Harrer—Bloomberg/Getty Images

Undersecretary for Health Dr. Robert Petzel has stepped down a day after being grilled in Congress amid uproar over alleged malfeasance and cover-ups at the Department of Veterans Affairs. Petzel said in September that he planned to retire this year

Updated 7:18 p.m. ET

Secretary for Veterans Affairs Eric Shinseki announced Friday he accepted the resignation of the official in charge of the VA’s healthcare services.

Undersecretary for Health Dr. Robert Petzel offered his resignation a day after sitting aside Shinseki while both men were grilled on Capitol Hill. Shinseki and Petzel faced questions Thursday about long-standing inefficiencies in the VA’s healthcare system, as well as allegations that VA officials covered up evidence of delays at a Phoenix, Arizona, clinic that may have led to the deaths of 40 veterans.

“As we know from the Veteran community, most Veterans are satisfied with the quality of their VA health care, but we must do more to improve timely access to that care,” Shinseki said in a Friday statement. “I thank Dr. Petzel for his four decades of service to Veterans.”

Petzel said in September that he planned to retire this year, according to the Associated Press.

“As the President has said, America has a sacred trust with the men and women who have served our country in uniform, and he is committed to doing all we can to ensure our veterans have access to timely, quality health care,” the White House said in a statement. “He has asked Secretary Shinseki to conduct a review of Veterans Health Administration practices and procedures at its facilities nationwide to ensure better access to care, and that review is ongoing.”

This post was updated with a statement from the White House.

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